=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518257500
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES A PEARCE, DDS, A PROFESSIONAL DENTAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2011
-----------------------------------------------------
Last Update Date | 04/12/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1221 COOLIDGE BLVD
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70503-2620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-269-0564
-----------------------------------------------------
Fax | 337-233-7801
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1221 COOLIDGE BLVD
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70503-2620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-269-0564
-----------------------------------------------------
Fax | 337-233-7801
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JAMES ALLEN PEARCE
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 337-269-0564
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 4099
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------